An emerging law-medicine ethics question: Are physicians still fiduciaries for their patients?

Technology and economics have a way of changing human interactions, sometimes for the worse. Case Western Reserve University Distinguished Professor Maxwell J. Mehlman insists the fiduciary obligation of physicians and patients must endure. Such relationships are built on trust.

Mehlman, the Arthur E. Petersilge Professor of Law and Professor of Bioethics at Case Western Reserve's School of Medicine, is director of the university's Law-Medicine Center. He is this year's recipient of the prestigious McDonald-Merrill-Ketcham Award at Indiana University-Purdue University Indianapolis, a partnership of Indiana and Purdue Universities.

Each year, the person honored presents a lecture. Mehlman presents "Are Physicians Fiduciaries for Their Patients?" as the McDonald-Merrill-Ketcham Award Lecture Thursday, Feb. 20, in the Wynne Courtroom, Inlow Hall, on the IUPUI campus.

Fiduciary relationships are those in which one party has a trust obligation to another and is in a position to take advantage of the other party, called the beneficiary or “entrustor,” Mehlman explained.

"The relationship between patients and physicians fits these conditions, as many courts and commentators acknowledge," he said. However, he has noted a trend to "reject or undercut the fiduciary nature of the patient-physician relationship. This is harmful both to patients and physicians."

His lecture in Indianapolis concerns changes taking place that can affect physicians, such as the increasing proliferation and sophistication of medical knowledge available to patients, the growing number of physicians employed by hospitals, and health plans that place a greater share of costs on patients.

These factors "make it all the more vital for patients to be able to trust their physicians," he said. "And the historical connection between the rise of medicine as a profession and doctors’ fiduciary obligations means that these obligations cannot be weakened without weakening the profession itself.”

The lecture and a following panel discussion will also consider whether physicians may ever act in their own self-interest at the expense of the patient's health; the circumstances in which physicians may sacrifice the welfare of one patient to benefit other patients or society; and whether patients can waive or modify the physician's fiduciary duty.